1. Deviations In Form And Size

As excess of development, we have here to mention the more or less complete repetition of one or more parts, which sometimes advances to such an extent that the bones of the jaws, the mouth, and the tongue are double, and unite in one common gullet. As defective formation, which may generally be distinctly traced to an arrest of development, we meet with complete absence of the cavities of the mouth and fauces (astomia), or imperfect development of individual parts, as of the superior maxilla, giving rise to an imperfect development of the face (ateloprosopia), Of the lower jaw (agnathia and atelognathia), of the lips (achelia and atelochelia), of the tongue, etc.

The most common and important cases of arrest of development are: Fissures of the upper lip, on either or both sides of the mesian line, corresponding to the union of the intermaxillary with the superior maxillary bones, which may or may not present a fissure also (harelip, labium leporinum); fissures of the palate, caused by the absence of the os incisivum and the middle portion of the upper lip, or by the mere disunion of the palatal processes in the middle line; or again, by defect in the latter on either or both sides, with or without an accompanying absence of the os incisivum; the fissures of the soft palate, varying equally in degree, from complete division to a mere indication of the anomaly in a slight notch of the uvula. Fissures of the tongue are extremely rare, and seldom present more than a mere trace of division; fissures of the nether lip, and of the lower jaw in the mesian line, are equally rare.

Closure of the mouth (atresia oris) is a rare occurrence, as contrasted with the frequency of a similar condition at the anus.

Numerous morbid processes are followed by anomalies that resemble the above congenital malformations, such as partial or total loss of the lips, of the cheeks, of the palate, contraction of the mouth to a degree approaching atresia, adhesion of the cheeks to the maxillae, of the tongue to the cavity of the mouth, contraction of the fauces, etc.

Increase of size, as a result of hypertrophy, occurs chiefly in the shape of hypertrophy of the lips and the tongue; it varies in degree, and is peculiar to the scrofulous cachexia and to cretinism; it is also presented as hypertrophy of the tonsils, and of the glandular stratum of the soft palate, as hypertrophy of the uvula, and occasionally of the gums.

The opposite condition, i. e. diminution of size and, taken in reference to the capacity of the oral cavities and the fauces, contraction, occurs in an eminent degree in the shape of atrophy of the tonsils, and also of the other muciparous glands, and of stenosis of the isthmus faucium. The latter results from cicatrization of syphilitic and scrofulous ulcers, and occasionally proceeds to such a degree that the isthmus scarcely permits the passage of a pea.

2. Textural Diseases

Of these, inflammatory processes, and especially those affecting the mucous membrane and its glands, demand primary consideration.

Catarrhal inflammation is particularly liable to attack the pharyngeal mucous membrane, and to be associated with a marked affection of the tonsils, in the shape of cynanche tonsillaris. It is either acute, or chronic, is apt to return, and become habitual; it frequently, and in many individuals constantly, passes not only into superficial ulceration, but even into phlegmonous inflammation and the formation of abscesses in the tonsils; or it leaves a permanent relaxation of the fauces, "with a varicose state of the vessels, elongation and oedema of the uvula, chronic hyperaemia, and tumefaction of the tonsils, and blennorrhoea of the tonsils and fauces. It frequently extends to the mucous membrane of the rima glottidis and of the larynx, as well as to that of the Eustachian tube.

The croupy process of the mucous membrane of the mouth and fauces occurs, in the first instance, in the well-known form of thrush and aphthse in children; and in adults, commonly with an epidemic character of an adynamic septic type, as malignant (gangrenous, aphthous) sore throat (angina gangrenosa, the diphtheritis of Bretonneau). In the former case, after a previous vivid or dark purple reddening of one or more papillae, and the vesicular elevation of the epithelium at the point and the sides of the tongue, dots or patches, of the size of a lentil or pea, appear on the inner surface of the lips and cheeks, and finally, on the mucous membrane of the fauces. They present an exudation, which has a frosted, or flocculent, or villous appearance, or is more of a membranous character, and extends into the cavities of the follicles; it is of a grayish, or yellowish-white color, and of a lardaceous, or soft, creamy, or fluid consistency; if removed, a shallow excoriated depression, surrounded by an inflamed margin, remains, on which the exudation is repeated, involving a further destruction of the mucous tissue.

In the second instance, livid spots, which rapidly coalesce, and become invested with a dirty, gray, shaggy, pultaceous and sanious exudation, form upon the softened, bleeding gums, and the mucous membrane of the cheeks, the fauces, and the tonsils. The gums themselves ultimately degenerate into a bad-looking, pulpy, sanious mass, and the mucous membrane of the cheeks and fauces, underneath the exudations, is equally found converted into a friable, fetid pulp, or a firm slough.

These processes often extend to the pharynx and the oesophagus, though scarcely ever to the respiratory passages; they are sometimes complicated with exudative processes on other mucous and serous membranes.

Genuine (primary) pharyngeal croup occurs rarely; it is either the result of an extension of tracheal croup, or, similar to exudative processes with products of a different nature, an anomalous process of a specific, acute, exanthematic, impetiginous, typhous character, or it is the result of a spontaneous or purulent disorganization of the blood. It not unfrequently leads to acute gastric softening.

Pustular inflammation occurs in the fauces in variolous disease; the mucous membrane being tumefied, and invested with a plastic mucous secretion.

There are other circumscribed inflammations of the buccal and pharyngeal mucous membranes, which are remarkable for their tendency to pass into ulceration, viz. the syphilitic, syphiloid, mercurial, and scrofulous inflammations. They are generally characterized by their peculiar red tinge and defined edges, and give rise to various products which dissolve the tissues in a peculiar manner, and consequently to specific ulcers. Syphilis, more particularly, is, in this phase of its existence, and so far as the alimentary tract is concerned, limited to the fauces.

The last-mentioned ulcers and aphthous ulcerations, give rise to more or less considerable loss of substance in the mucous membrane and the subjacent tissues, after the cure of which, white, indurated, elevated re-tiform, and tendinous cicatrices remain, which induce a corresponding contraction.

Among the inflammations attacking individual structures, we have to mention inflammation of the gums, especially the rheumatic variety, with coexisting affection of the alveolar periosteum, as also the scorbutic forms and the inflammation of the tongue with its occasional termination in deep-seated suppuration.

An important disease that we must here speak of, is noma, a phagedenic ulceration which commences at the inner surface of the cheek, and rapidly spreads, involving the soft parts in gangrenous destruction. A livid congestion of the mucous membrane precedes, corresponding with which there is an erysipelatous redness externally; a hard tumor then forms; the tissues are broken up into a pulpy sanious mass, the subcutaneous cellular tissue is dissolved into a pale yellowish, gelatinous, oily mass; the superficial integument, at the same time, becomes pale, and is converted into a similar mass, or dries up into a dry, brownish-black eschar; the surrounding parts presenting erysipelatous redness and oedema. This process not unfrequently spreads over the entire cheek and gums, denuding the maxillary bones, and involving them in a species of calcination. (Froriep.) It is rarely met with except in children, and commonly attacks weakly cachectic individuals; it frequently occurs as a sequela of exanthematic diseases, and of typhus, and then represents a degeneration or an anomaly in the latter.

3. Adventitious Growths

Among these we have first to notice the fibroid tumors occurring on the alveolar processes under the name of epulis, and in the fauces as polypi; they have a broad base, or are pediculated, are of soft or hard texture, of a rounded, oval, or lobulated form, and are invested with a spongy, ulcerated, and often bleeding mucous membrane.

Cancerous morbid growths do not often occur, if we except two cases in which a malignant tumor has made its way into the mouth or the fauces from without. Cancerous degeneration of the tonsils is peculiarly rare, and the cases that have been recorded as such have almost invariably proved to be instances of mere hypertrophy with induration. Still cancer of the lips, and especially of the nether lip and of the tongue, where it chiefly attacks the posterior half, is not unfrequent; from these points it branches out between the muscles at the floor of the mouth, at the sides of the fauces down to the neck, and on the tongue it gives rise to an irregular, sinuous, callous, and fungous ulcer, which is surrounded by an indurated margin of mucous tissue.

4. Anomalies In The Secretions

We have, under this head, to notice, in addition to those already spoken of, the different secretions which cover the mucous membrane of the mouth, and especially of the tongue, in various chronic and acute diseases, and the concretions occurring in the sinuses of the tonsils. In scrofulous subjects the tonsils are often affected, in addition to hypertrophy and habitual hyperaemia, with a peculiar blennorrhcea, and the purulent secretion not unfrequently becomes inspissated, so as to form tubercular cheesy plugs, or even chalky concretions. These, in their turn, keep up a perpetual state of irritation in the tonsils.